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HomeMy WebLinkAboutMiscellaneous - 43 FULLER ROAD 4/30/2018 43 FULLER ROAD 210/065.0-0077-0000.0 r i Location No. r4d Date r s NORTH TOWN OF NORTH ANDOVER F 9 }s Certificate of Occupancy $ U sS �° EBuilding/Frame Permit Fee $ 471-)471-)�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� Check # i 3 L 1 3 - Building I�+sp�etor ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ]may '_ r . `� n.<}"� �•��i 4kH"'4S'� .ti.,�f ��VE �M.°1 .c�"'�'`—�`• �` -�.r;.'� � 1 Ndt e.,�Z�S �$ � K, •` BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATUR.9/ (Au—ir&n—g Commissi /I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number � �tsc.�c..�YC 2�. �A►�Oo�c=rZ . 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Punt) Address for Service i Signature Telephone 2.2 Owner of Record: Name Print Address for Service: zM p�qy 4 Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ a v� �,A G G`l l Z d Licensed Construction Supervisor: � '30 l License Number Calc ��tUL / �r1 Addressqa4 r2f�� �� 3 Expiration Date SignatuU Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name , p!1 Registration Numbe r Addressa- I"�—F / / �f Expiration Date !� V LSig reTele hone G) SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be - 'OFFICIALUSE,ONLY Completed by permit applicant 1. Building (a) Building Pernrit Fee P>, 6-C> Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _T I, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ;as Owner/Authorized Agent of subject property ,, Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Jn Signature of Own r/ gent U U Date low NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH r Town © ` 4Andover === A o dover, Mass., COC HICHEWICK A0 ATED P' Cl S BOARD OF HEALTH PER T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT..... . . ...... .... .. .......... ... .. ........ .................................... ............ Foundation has permission to erec ... ............ ................ build' son ... .. .....�............. Rough tobe occupied a�� .�.. ... ..... ........... .................................................. Chimney provided that the person accepting this permit sh in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS ARTS Rough .......... Service �- G SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Rough Place on the Premises — Do Not Remove Fina, No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. t ✓!ze �an�aruuea�a���«oeac�c�re� r DEPARTMENT OF PUBLIC SAFETY ` CONSTRUCS.-ION.SUPERVISOR II6HSE- Number Expires: Blrthdatec g ° Cbl , 88928 A41®3128 ` ,@41831195 4 Restrrdted Tbr r '01 JOHN 11tIINZAFAME 38 TEMPLE'DR l .+..�xVtt4--'METHUEN, MA 81844 i • / a1 gi Comrnerci, • • es�aert, l*oo�� Licensed & Insured • Roof Leak Experts • (978) 794-3883 • 1-800-WAIT-4-US Proposal Submitted To Phone Date Streets �- Job Name __jCity,State&Zip Code Job Location Job Phone We Propose hereby to furnish and labor in accordance with specifications below, for the sum of: Dollars ($ All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices.Any alteration or deviation from specifications be- Signature: �-- low involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents NOTE:This proposal maybe or delays beyond our control, Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. We hereby submit specifications and estimates for: az XiC- �'.�i.:9"7,��1.� ✓,etc r--� C(/ _ .�_ezr� Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment Signature: will be made as outlined above. Date of Acceptance: Signature: r ' Mme+.Molt MEMO MN �r owr as in LEE dw~ . eu�r tier cwt�wM .'pwb'Gqm1m~ Mm Nov Minstar ' ` 'i"«+wof � �T A11M7?6 Now ! I I K+11f''tM to I t mer" 0 No NW&M*&a"art!AddfMa 1. Ail Under Orta Aoe11PsM M Peas Lrnt pt k1sN1w"Ag0W Nor"Andslrst, MA 018" � Lgmo,!Nip MA.DIM ; FED 10 Nurniar: 02CMSMA MCCI Caw w Cees Ilk • 31171 Pisk C"o.: -1143900 0ww watt m"mal Mown above,No" s wr WOW" 2 PONCY PSMo0- 11MMM b 11J0ol200012:01 an+standard Itne at the�nlWsd'a Erna aednss. 3A. Work"Ca>flpsrW",Waurwm.poor*Ons of he peli0y s,,a es to the Weikers CompMmtlan isw and any oseupakrW d*mn taw of each of"NOW 1910d%M+a: IAA 39. Employare Uaft"WWI" Part Two et ft poky aopwe!)cffvoyers rlae my IFswarros%two*in ssch Mie Naiad In Nam 3A. Tna L,.Uttid of Lko ft air: ftdprt"by AsskWa :100,000 Eooh l". 4oyas Soft M+iuyr Oy a""* :000,000 PwcY;.h k 800 w4wry by cw w 1100,000 too Acolent 3C Ot?w 8100 inwrar,aa Part Three of the 00i4y aoparea to :Ae ata%a' g ani.listed hers. All rafts except "V•I+lp,Oh,WA.WV.Wtr she go"$doagnalaf in Wp 3 a c►&*Inkrms+ ort Pae. 30. T%perky'"Wim Maas wwft unert;a and S N UW: ass Nuad sd selydu+s. 4, 1'►,s �atk para►win e.0elMnta+ed oy but�L e1�,��4:lss.Cl.isdreuer+s.lin.. and PAM112 Plans. AN M "".8 suked to varlAC6111 In a"Ohahp by su" • '' "�a�« +a+M ea"*a n: Para, � oauon of operweo„, 4160 r oqk+ta1 Coratanl: lees I-'.Vmditd Mm" P►MnW CWM*ft Lev*, lldll Ceu"1ors+0rd 11/7u��Ag .-----_ T+►io mftwmatisn Pave w11h - Y��°Ae1ps ►a�a �erR�oys►s t.aen�y Msursrtos Poi+oy and erWj"TT ,tt sn ,s part"000 of "OWN Ons Mars rNNr+bar porky. OMs at t��s/teaa Nim CopyWC 00 00 01 tV(lam) 16"m eST� Kt tai A--WNW •?w t sow►-�v�.rr,� Date..C TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......ra ....... .............. has permission to perform ........ft..!..( (C.11,P.44........... .......... .... .... .. ............. f............. C',"I C wiriQg in the building o ...... at .... .......... ..3......r . Alf ...... ...........No"dove F17K)1.C)0 L i c.No. .......... ............ ................. LICAL P**E*C-Too Check # 4334 Z'HF COMMONWEALTH 0FA11 SSACHUSE7TS Office Use one DEPARTIVffM0FPUXJCS4FE7Y Permit No. BOARD OFFIREPREVHMONREGUT4770NS527C3Ml2.00 ' Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 3 ICU Ile-r- /JJ Owner or Tenant ,j "g,si C Owner's Address Is this permit in conjunction with a building permit: Yes rZ7rNO (Check Appropriate Box) Purpose of Building %�Cy�rod e f l`th-CA Utility Authorization No. Existing Service AV© Amps / Volts Overhead Underground r--J No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity lation and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA . No.of Lighting Fixtures / Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets /0 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets /,2 No.of Gas Burners No.of Ranges / No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of DIsAlwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of DryV.rs Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• TtmnatloeCovaa�Rust>a�Ittothe�of�C�alLaws Ibaw aamaiLiab&yhmuua=Fblic.7+in kx&gCo a Cover'ageayss kswUe4w ala# YES �/� NO Ihavesubm0ledvandptoofofsametDlh--011iM YES F)cuharechadodYES,plemm6cwthetypeofeoNuag-,by cheddngtheMxTdalebox INSLIR ANCE BOND OrIHE1t - to -1.17 r � Y) D W /r 0 3 Estim*dVairofEbcft alWotk$ Wolicv%t © S hj)ec imDate >wdiJI .& Fetal Si gnaduncff&Pataltiesof n FIRMNAME /�,. �,tdu ,�I C �N•< Iic=No. 3 3 6.20,F I1Ce<1SeNo &isau=Tel.No y.32-6,x.3 4�irtrPcc ©c, /r✓I O 3dJ`3 I At Tei No L 2-—rf-7 3 DWNER'SINSURANCEWARUII lamaware[hatth-lic=doLothaveth mailamecDvuageorits atsmtdeqwvaiE%IasreqLuiedbyNb%admsez Ctned Laws and thatmysignah_ueondmpemt apphcahon waives this tegamrri t :Please check one) Owner ® Agent Telephone No. PERMIT FEE$ Signature ot Uwn—er or gen Date."2'(�- US TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� � .. � Jorw) e-�This certifes thatQ . . ! . . . . . . . . . . . . . . .a has permission to perform . . .R'R plumbing in the buildings of . A A 'R . . . . . . . q. . . . . .. [`Q ... . . . .. . . . . . . . . . .. North Andover, Mass. at. . .9 3. . . - 1 ,-e Fee. .f . .Lic. No a����8 . -.�u?2! !./r. .•` . . PLUMBING INSPECTOR Check # ' 5514 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMPING .I y (Type or print) NORTH ANDOVER,MASSACHUSETTS J �% 1 / Date L O Building Location Owners Nam 4l f �l� �/! C Permit# / Amount T e of Occup ancy New13 Renovation Replacement Plans Submitted Yes. No P" . 1:111 FIXTURES Cr Cr Cn oil B�1�TT 1S'�kYD(gt 4II1 . 11x�Z S>GH_>N1€Li (Printor type) I :Check one: Certificate Installing Company Name Corp. Address / / /fit' l��. . e r�l; Partner. usiness Telephone - - Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate.the type of insu ce coverage by checking the appropriate box: Liability insurance policy Other type of indemnity r Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance ignature OwnerEl Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the bestbf my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa set State Plum g CoXanq4gaTter 142 of the General Laws._- By: igna ure x5i Licensedum r T pe of Plumbing License Title City/Townicense NumDer Master D Journeyman .APPROVED(OFFICE USE ONLY Location 113 3 " //P 9 J No. 3& � Date �_a 3 NORTH TOWN OF NORTH ANDOVER 0 n Certificate of Occupancy $ �'�a'CHU • Eta' Building/Frame Permit Fee $ s�cHus Foundation Permit Fee $ f ' Other Permit Fee $ TOTAL $ S Check # C1 16122 f Building Inspector Inspector t TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING jy�e_, ipf■�iypp ✓ .- .�,,,,,,s ,?kf ,CS c':.,' ;,.:'�T�115�f0{;.MRs�}5C Vital i'l" Yf �Y — #at BUILDING PERMIT NUMBER. DATE ISSUED. 3 � � o03 X SIGNATURE`. � Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: V 6— 77-000. o n Map Numbef Parcel Number W 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public W' Private 0 Zone Outside Flood Zone 3 Municipal 0 On Site Disposal System SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record r K it 72.rr,' i^ ,`P hl3 4-ll-e r ad � Name(Print) �c - / - Address for Service: J Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ SC Q±t j. J-0. 0,-,n 7� t Licensed Construction Supervisor: & a / License Number ad 4-oltiju14 df.-r'4 Av //, D Address Lt' / 6 0 3 V37 -9951O Expiration Oate Signature C7 Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v PL-0-r t4onc A-ao Company Name Z cl J' m � + // // 1 I '/ Registration Number r / 6 f i f�"% Q d.. k-u n C A I u N?/'r,,t /L; Fl Address r I_,� (7r /3' oa3 Z ,� R7'rYN'/ f.9 0 3 L/3'7 19 W O Expiration ate /1 Signature Telephone V I 4 SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) ' Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......CK No.......❑ SECTION 5 Description of Proposed Work check all licable New Construction [IExisting Building [IRepair(s) ❑ Alterations(s) .B' Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Vt Q rn o't- ws/'',-r K`-'ta ti c✓t /bt C..-Y A Cw el SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICCIAL USI';+ QNLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical ,k (b) Estimated Total Cost of Construction 3 Plumbing ti p o� Building Permit fee tel X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) 51 V11. & Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize C] �— ���� ( _/.j-t e o„., to act on My behalf,in all matters relative to work authorized by this bui ing permit application Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, S(' -5. ��o:n t as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief .J”C o.Yf J. C Print ame 0606 -/� ) Signature of Own /Aent Date 3 NO. OF STORIES SIZE BASEMENT OR SLAB e ¢ SIZE OF FLOOR TlIvIBERS Isr2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Page I CONTRACTOR AGREEMENT THIS AGREEMENT made the 12-day of December,2002 by and between Scott J. LaPointe hereinafter called the Contractor and Mark and Terri Strangle,herein after called the owner(s). Witnesseth,that the contractor and the owner for the considerations named agree as follows: Article 1. Scope of the work The contractor shall furnish all the materials and perform all the work shown on the Drawings and/or described in the Proposal 2071. Specifications entitled Total price and quantity as annexed hereto as it pertains to work to be performed on property 43 Fuller Rd-N. Andover Ma. Article 2. Time of completion The work to be performed under this Contract shall be commenced on or before, and shall be substantially completed on or before -1-ii - c3 Time is of the essence. The following constitutes substantial completion of work pursuant to this proposal and contract:when all items in proposal 2071 have been completed. Any change orders written once the job has started will add time to the completion date and will be stated in the change order. Article 3 the Contract Price The Owner shall pay the Contractor for the material and labor to be performed under the Contract the sum of Fifty-one thousand four hundred eighty-one Dollars and sixty-four cents. ($51,481.64) subject to additions and deductions pursuant to authorized change orders. Article 4. Progress payments Payments of the Contract price shall be paid m the following manner: Deposit upon signing of contract.............................. .................... $6400.00 Payment#1 Start of job site work....................................................$8316.20 Payment#2 Start of electrical................................I....................... $8316.20 Payment#3 Start of drywall ...................................................... $8316.20 Payment#4 Start of cabinet install.................................................$8316.20 Payment#5 Start of painting........................................................ $8316.20 Payment#6 completion of job......................................................$3100.00 Page2 Article 5. General Provisions Any alteration or deviation from the above specifications, including but not limited to any such alterations or deviations involving additional material and/or labor costs,will be executed only upon a written order for same,signed by owner and Contractor,and if there is any charge for such alterations or deviation,the additional charge will be added to the contract price of this contract. If payment is not made when due,contractor may suspend work on the job until such lure to make payment for period in have been made.A fay Pe time as all payments due Pym excess of seven days from the due date of the payment shall be deemed a material breach of this contract. In addition the following general provisions apply: L All work shall be completed in a workman-like manner and in accordance withal] building codes and other applicable laws. 2. The contractor shall furnish specifications for home improvements,a description of the work to be done and description of the material to be used and the equipment to be used or installed,and the agreed consideration for the work. 3. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 4. Contractor may at his discretion engage subcontractors to perform work hereundre, provided contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this contract. 5. All change orders shall be in writing and signed by owner and contractor,and shall be incorporated in,and become a part of the contract. 6. Contractors at his own expense obtain all permits necessary for the work to be performed. 7. Contractor agrees to remove all debris and leave the premises in a broom clean condition. Page 3 S. In the event owners shall fail to pay any periodic or installment payment due hereunder,contractor may cease work without breach pending payment or resolution of any dispute. 9. All disputes hereunder shall be resolved by binding arbitration in accordance with rules of the American arbitration association. 10. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes,casualty or general unavailability of materials. 11. Contractor warrants all work for a period 12 months following completion. Any work performed by any subcontractors not hired by K-A-T construction will not be covered by K-A-T construction. 12. The contractor shell furnish a list of all items that are to be supplied by the clients. And the stages when these items are to be on site. Article 6.insurance The contractor represents that it has purchased,and agrees that it will keep in force for the duration of the performance of the work,or for such longer term as may be required by this agreement,in a company or companies lawfully authorized to do business in the state of Massachusetts. Such insurance as will protect K-A-T construction and the owners of the site from claims for loss or injury,which might arise out of or result from the contractor's operations under this project,whether such operations be by the contractor or by a subcontractor or its subcontractors. Upon signing. I agree to pay for the above stated work that is to be performed under the conditions as specified within. Customer signature date : '� Customer signature date K-A-T Representative ,_ date W m'�� »°�'^��r •.. m�td� , ;zy...,,.Gif.vw.w4a+k»r .� gay,p : " ii� girl `y�?` - f,�d�i►Rt3�'�1JILpING IiEOtJLAT{©t`I� i `' Licgryte' CONSTftJC7tON SUPERVIf)R fi V 4 Resttrict+bct° tag SC(3TT! i.APOtN � LONDONbEI3RY t3H 081353 Adr►►nrstrat�r r � :A Board of Building Regulations and Standards y. HOME IMPROVEMENT CONTRACTOR Registration 129364 Expiration 0$!18/2003 Type .Qei4 K.A.T Constuction Scott Lapointe 9 GRIFFIN RD. Londonderry,NH 03053 Administrator I u The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address 1 �r.` A !� d Cit} n d,:;4 J.v/rte Q> i Phone# `a o3 17139- 9VVo Insurance.Co. -e u in Ur ,,r. / Policy# 14.,/7 l F k Company name: Address City Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment_as well_as.chni penalties in.thelbrn-cf-aBTOP WORK_ORDER and_a.fine_of_($1110.00)-a day.againstme. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Date- z Print name 5'rof t" kcAe);'a-le Phone.# 6,93 V-17-F�Iyo Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept ❑Check if immediate response is required Licensing Board p Selectman's Office Contact person: Phone#: I] Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A.. The debris will be disposed of in: w -1 (Location of acilit I_Z:ebo-tt I lag-ZL.— S' nature of Permit Applicant 22 / 03 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector NpRTM ED Town of rAndover ` O No. 3 T` Q dover, Mass., o';? COCN�C � SRATED P'" Cl 1 4 BOARD OF HEALTH Food/Kitchen T T Septic System PERM U M fir. BUILDING INSPECTOR THIS CERTIFIES THAT.../ " ' .... /. . .. . . .. � .f......... ....... .0!............................................. Foundation has permission to erect.... .. ............... .......... buildings on ........... Rough to be occupied as.......� f � � 1 � �N 4f AXterms. �- R*��*!V.�. .. Chimney ...................................... ...... ........... .................... ......... ............... .............. provided that the person accepting this permit shall in every respect conform to of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 6 S oh>/� S�Q PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERIT EXPIRES IN 6 MONTHS Final M UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ...... ................................ ......................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ..__. .=.�A. N►8.{►3_ At��[. _OA��f G.� ���, ._- -----:�cd1ti 1��1Y_��i��.�::.�7I�IY�=-� - - t INC V. o v _ WX70 -16u O f rag ID AMIK - Iti— _ _ _- WALL- ---LaiNA w -lee 40 x f AV 0 e i i - 1 fe- __ flet Please Note: - Contractor is to check and verify al d�triensiorts t3 '1�s1 and conditions at job site during construction of ttxs project and is to review al variations from HErMW Kwm..r%,k sW"ftwc MftWO K "77 proposed drawings w h Ard itect and/or Owner WOODS "`"" "" ' s'*"""°"'" before toceedin9' fel ss+aooe• tsoat z +